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Eur Respir J 2007, doi:10.1183/09031936.00021007
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ORIGINAL ARTICLE |
Sepsis severity predicts outcome in community acquired pneumococcal pneumonia
1 Medical Clinic III, University of Lübeck
2 Institute of Microbiology, University of Lübeck
3 Institute of Microbiology, National Reference Center for Streptococci, University Hospital (RWTH), Aachen
4 Medical Clinic, Research Center Borstel
5 Thoraxzentrum Ruhrgebiet, Klinik für Pneumologie, Beatmungsmedizin und Infektiologie, Augusta-Kranken-Anstalt, Bochum, Germany
* To whom correspondence should be addressed. E-mail: schaaf{at}uni-luebeck.de.
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Abstract |
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Easily performed prognostic rules are helpful for guiding the intensity of monitoring and treatment of patients. The aim of this study was to compare the predictive value of the sepsis score and the CRB-65 score in 105 patients with community acquired pneumococcal pneumonia. In addition we investigated the influence of timing of the antimicrobial treatment on outcome. The sepsis score and the CRB-65 score were used to allocate patients to subgroups with low, intermediate and high risk.
Comparable, highly predictive values for mortality were found for both scores: low risk group: 0 vs. 0 % (sepsis score vs CRB-65), intermediate risk: 0 vs. 8.6 %, high risk: 30.6 vs. 40 %, AUC 0.867 vs. 0.845. Patients with ambulatory antibiotic pre treatment had less severe disease with a lower acute physiology score (p=0.02), lower white blood count (p=0.002) and a faster decline of CRP levels (p=0.03). No pre treated patient died.
In summary, both scores performed equally well in predicting mortality. The prediction of survival in the intermediate risk group might be more accurate with the sepsis score. Prehospital antibiotic treatment was associated with less severe disease.
Keywords: Antibiotic treatment, pneumococcal infection, pneumonia, risk classification, sepsis
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